Lu An-Ting T, Salpeter Shelley R, Reeve Anthony E, Eschrich Steven, Johnston Patrick G, Barrier Alain J, Bertucci Francois, Buckley Nicholas S, Salpeter Edwin E, Lin Albert Y
Santa Clara Valley Medical Center, San Jose, CA 95128, USA.
Clin Colorectal Cancer. 2009 Oct;8(4):207-14. doi: 10.3816/CCC.2009.n.035.
The use of adjuvant therapy in stage II colorectal cancer (CRC) remains controversial. There is a need to identify more effective predictors than the traditional staging system to aid therapeutic decision-making. We performed a systematic review and meta-analysis of gene expression profiles (GEPs) to assess their utility for risk stratification and prediction of poor outcomes in stage II CRC.
We performed a comprehensive literature search through December 2007. Studies were included if they reported GEP-based assays in patients with stage II CRC, and either subsequent cancer recurrence or death within 3 years. The prognostic likelihood ratio (LR) and odds ratio (OR) were calculated with 95% confidence intervals and pooled using the fixed-effects method. The weighted average sensitivity, specificity, and accuracy were also reported.
Eight cohorts involving 271 patients contributed to the analysis. The average accuracy, sensitivity, and specificity were 81.9%, 76.2%, and 84.5%, respectively, with a prognostic LR of 4.7 (95% CI, 3.2-6.8) and a prognostic OR of 15.1 (95% CI, 7.9-28.6). No evidence for significant interstudy heterogeneity was noted in either analysis. Subgroup analysis found no difference in results for the prediction of cancer recurrence or death.
This analysis demonstrates the promising potential of using GEP assays as predictors of poor outcomes in stage II CRC, such as cancer recurrence or death. To maximize their utility and availability, further studies will be needed to identify and validate specific gene signatures for poor prognosis in stage II CRC.
辅助治疗在II期结直肠癌（CRC）中的应用仍存在争议。需要确定比传统分期系统更有效的预测指标，以辅助治疗决策。我们对基因表达谱（GEP）进行了系统评价和荟萃分析，以评估其在II期CRC风险分层和不良结局预测中的效用。
我们对截至2007年12月的文献进行了全面检索。纳入的研究需报告对II期CRC患者基于GEP的检测，以及随后3年内的癌症复发或死亡情况。计算预后似然比（LR）和比值比（OR）及其95%置信区间，并采用固定效应方法进行合并。还报告了加权平均敏感性、特异性和准确性。
八项队列研究共纳入271例患者参与分析。平均准确性、敏感性和特异性分别为81.9%、76.2%和84.5%，预后LR为4.7（95%CI，3.2 - 6.8），预后OR为15.1（95%CI，7.9 - 28.6）。两项分析均未发现显著的研究间异质性证据。亚组分析发现，在癌症复发或死亡预测结果方面没有差异。
该分析表明，使用GEP检测作为II期CRC不良结局（如癌症复发或死亡）的预测指标具有广阔前景。为了最大限度地发挥其效用和可及性，需要进一步研究以识别和验证II期CRC预后不良的特定基因特征。
